Grading Staging Report – Diffuse Large B Cell Lymphoma – Surgical Pathology Criteria

Grading / Staging / Report

  • Diffuse large B cell lymphomas not currently graded

    • Previously, the immunoblastic variant was considered high grade

      • Subsequent studies have shown no difference in prognosis

    • Adverse prognostic factors reported include

      • High prolferation rate measured by Ki67 staining
      • bcl2 expression
      • p53 overexpression

Ann Arbor Staging System

  • Stage I

    • I if involvement of a single lymph node region
    • IE if involvement of a single extralymphatic organ or site

  • Stage II

    • II if two or more lymph node regions on same side of diaphragm
    • IIE if localized involvement of an extralymphatic organ or site and one or more lymph node regions on the same side of the diaphragm

  • Stage III

    • III if Involvement of lymph node regions on both sides of the diphragm
    • IIIS if spleen involved
    • IIIE if extralymphatic site involved

  • Stage IV

    • Diffuse or disseminated involvement of one or more extralymphatic organs or tissues, with or without associated lymph node involvement

  • Systemic Symptoms in 6 months preceding admission

    • Fever, night sweats, 10% weight loss
    • A = absent
    • B = present

  • Extranodal sites are also designated

    • M+ = marrow
    • L+ = lung
    • H+ = liver
    • P+ = pleura
    • O+ = bone
    • D+ = skin and subcutaneous tissue

  • Although originally designed for Hodgkin lymphoma, the Ann Arbor System is also used for non-Hodgkin lymphomas.

The pathology report should contain the following information:

  • Diagnosis in the World Health Organization (WHO) classification

    • Equivalent diagnosis in other classifications used by relevant clinicians

  • Results of supplementary studies if performed
  • Relationship to other specimens from the same patient
  • Information relevant to staging if available

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